Research Project Proposal
According to the results of studies that were held by the World Health Organization, heart diseases are the leading cause of morbidity and mortality in most industrial countries. A few steps, such as data collection, accurate epidemiological information, and cardiovascular risk factors assessment have been identified as the primary measures for the promotion of health and activities to reduce risk factors, improvement of people’s health, and reduction of the mortality level. The American Heart Association also defined several risk factors which are conducive to cardiovascular diseases, elevated LDL (low-density lipoproteins) cholesterol levels are among the most widespread of them (Pampel, Pauley S, 2004). The revised 2018 guidelines on screening and management of cholesterol by the American College of Cardiology/American Heart Association (ACC/AHA) allows for more personalized patient management compared to the 2013 guidelines. The new guidelines recommend that healthcare providers conduct a detailed risk assessment and discuss treatment options with patients, recognizing the importance of identifying and managing high LDL levels. These guidelines are not enough without a provider and patient partnership to manage high cholesterol.
Background and Significance of the Problem
The Center of Disease Control and Prevention (CDC) stated that in the United States approximately 55% of adults had elevated LDL blood levels, fewer than 50 % of patients with high LDL levels receive treatment, and sequentially 31 million of Americans have total cholesterol levels above 240mg/dl. The prevalence of high cholesterol levels increases depending on income rate, noticing the low-income population with the highest LDL level. Data showed that one out of every three adults with high cholesterol levels has the condition under control. Men and women of Hispanic Ethnicity are the highest impacted population ranging from 9 to 13%. Hyperlipidemia is a recognized risk factor for the incident of acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF). High LDL Levels are known to cause 4.5% of death. High cholesterol itself is not a disease, but it can lead to serious health consequences. Every 40 seconds, an American adult dies from a heart attack, stroke, or related vascular disease. These conditions claim the lives of more than 800,000 Americans each year with 150,000 of them under age 65. According to the Centers for Disease Control and Prevention, 71 million Americans have high cholesterol. Still, two out of three do not have it under control, and that has severe consequences for patients and society. A report commissioned by the AHA found that in 2010, heart disease cost the U.S. $273 billion in direct medical costs and projected this would reach $818.1 billion by 2030. The report also found that heart disease will cost the nation billions in lost productivity, increasing from $172 billion in 2010 to $276 billion in 2030.
Statement of the Problem and Purpose of the Study
The purpose of this paper is to identify primary care providers’ Barriers and facilitators on cholesterol screening, diagnosis and management. It also identifies low or sub-optimal rates of lipid screening in primary care due to inappropriate screening (thus missed opportunities for prevention of CV disease). High cholesterol increases the risk of heart disease and stroke, which are the two leading causes of death in America. Guidelines advise assessing factors such as age, gender, race, tobacco use, blood pressure, diabetes, to start pharmacologic interventions based on ASCVD scores.
Literature Review
Algeel et al. (2018) contend that the development of cardiovascular diseases is profoundly linked to the lipid levels in the body. Therefore, there is a need to utilize practical screening guidelines for cholesterol levels among patients to control the prevalence of cardiovascular diseases which eventually lead to increased mortality and morbidity rates (Carratala-Munuera et al., 2015). Research has identified inadequate screening and lack of early testing for lipid levels as the leading factors for heart diseases and stroke (Grant et al., 2018). Reports have also indicated that in every forty seconds, a patient is dying because of cardiovascular diseases in the United States (Lowenstern et al., 2018). Therefore, there is an increased need for the current study to evaluate the barriers that hinder effective screening for lipids levels and implementation of effective control measures (Grant et al., 2018). Previous literature has shown that multiple health behavioral changes and transformations are valid to the control and timing of the effects of cardiovascular disease (Grant et al., 2018). The relationship between the healthcare practitioner and the cardiovascular disease patient is essential, further, this increases the patient’s willingness to adapt and accept the assigned changes (Alageel et al., 2018).
Additionally, the work motivation among the healthcare providers to set comprehensive screening methodologies together has been shallow (Lowenstern et al., 2018). Facilitators of effective control and management of cardiovascular disease have been linked to the continued support and advice to the practitioners on ways to roll out the interventions (Lowenstern et al., 2018). As such, with the requisite support screening for the lipid contents has been simplified. The utilization of modern technology and its development to give interventions that are easy to monitor has been highlighted (Carratala-Munuera et al., 2015).
Research Question
This project questions were aimed to find what interventions are effective in improving lipid screening rates in primary care settings among patients older than 18 years of age?
Hypothesis
Increasing education time during provider-patient encounter, implementing new screening tools such as electronics for provider and patients will decrease the risk of high cholesterol levels among the adult population.
Null Hypothesis
There is no difference in cholesterol levels on patients screened often than those only screened once a year by primary healthcare providers.
Variables
The study aims to determine the effectiveness of proper primary care provider education in reducing mortality rates associated with high cholesterol and decreasing the need for treatment due to effective early screening and management. Based on the purpose of the study, there are three variables. The independent variables include proper education and barriers to effective cholesterol screening. These variables do not vary with changes in other variables. Instead, they vary to effect change in the study. The dependent variable, on the contrary, is proper cholesterol screening within primary care providers.
Theoretical Framework
There is a need to evaluate the various behavioral and cognitive antecedents that influence primary care providers in performing cholesterol screening in patients efficiently. The framework thereby develops a structure that can be implemented in the determination of barriers to effective cholesterol screening and establishment of functional intervention to eliminate the barriers. Principles of Fischbein and Ajzen’s (1975) theory of planned behavior (TBP) are used in the evaluation of the personal motivational factors influencing people to behave in a particular manner. According to the theory, motivation or behavioral plan is the driving force in any behavior in the achievement of any intended objective. These intentions are the behavioral control factors and providers of beliefs and norms that determine how care providers screen patients in the assessment of lipids levels.
Overview and Guiding Proposition
Therefore, the theoretical propositions extremely significant following that they provide the equations and correlations that are essential in guiding the research. One of the propositions is some of the practices or behaviors like consumption of food products with high levels of cholesterol leading increased lipids levels are directly affiliated to other correlated behaviors. Furthermore, the behavioral control factors among individuals are also closely linked to the health care providers’ actions in screening patients while testing for lipids levels. On that note, the control interventions implemented by individuals in the regulation of cholesterol levels profoundly determine those used by the health practitioners in the evaluation and diagnostic tests.
Application of Theory to Study Focus.
The theory is applied to the current study following that it facilitates the identification process used by researchers in the establishment of the influencing forces that enable primary caregivers to undertake proactive cholesterol screening in health care facilities. Furthermore, the identification of these barriers is essential in that it provides the study with methodologies to employ in the establishment of interventions appropriate to eliminate them.
Methodology
A sampling of the study population where eighty patients and health care providers participated in the study was done. The study population was sampled randomly regardless of gender, race, ethnicity, socioeconomic status and age, excluding individuals under the age of eighteen. The study used a mixed method of collection and analyzing data, including an explanatory sequential design in the collection of quantitative data.
Extraneous Variables
Controlled variables are the number of patient selected for the study, participants age above 18 years of age, patients with a high risk of cholesterol, patients diagnosed with high cholesterol receiving therapy or not yet enrolled in statin programs, participants with multiple comorbidities.. Uncontrolled variable applicable to this study; patients not following up appropriately, participants pharmacologically not compliance, economic and physical limitations, healthcare providers and patients not returning survey questionnaire.
Instrument
The questionnaire is the instrument that will be used in this experiment and internal data extraction. To begin the study medical data will be extracted to determine metrics, compare and analyze past interventions and appropriate interventions to improve cholesterol screening among the adult population in conjunction with this healthcare participant will be given a questionnaire to fill (Street, 2018). Validity will measure the amount since the questionnaire cannot be 100 valid.
Intervention
The author of this study will use test-retest to tell the consistency of a measure. A pre-test will be conducted for both providers and participants with the appropriate screening questionnaire to understand methods used from the provider and patient knowledge. Within the next encounter visit, a posttest will be conducted to the same group after the new interventions are implemented to re-evaluate the level of understanding and determine if new interventions can be implemented to improve the outcomes. The researcher will observe reliability to say the degree to which the observer gives consistent answers. Internal consistency will measure the resulting consistency across items (Stylianos, 2018). This intervention aims to see what chances of the participants are developing high levels of cholesterol if they are eating healthy and keep physically active, economic or emotional problems, family and cultural beliefs related to eating habits. Also, it aims at habits like primary care providers not addressing, education and screening participants appropriately, lack of providers utilization of education tools, guidelines and following up in time. In general, the intervention will take 20 hours weekly for the course of 3 -4 weeks to collect and study data between these family providers offices to determine how to improve cholesterol screening. This will be done by incorporating electronic tools, digital education, adding extra time to the patient-provider encounter to assess and teach external factors making the participant at risk for high cholesterol, educate patients regarding possible related comorbidities (Stylianos, 2018). In the research, the questionnaires will be filled by each participant and return. This technique is the best to collect information since it is cheap, easier to use, and where literacy rate is high, the contributor will cooperate well.
Data Collection Procedure
In this study, the author sued about 80 patients with high levels of cholesterol to carry out the research. The patients have been observed in pre and post-intervention. It is essential to use inferential statistics when analyzing data (Bastos Brito & Carvalho, 2017). Data collection will use descriptive and inferential statistics to analyze the participant’s information. This paper will mainly focus on data analysis of patients with high levels of cholesterol. Descriptive statistics with the use of graphs to analyze and summarize data will be used in a meaningful way among participants with a high level of cholesterol.
Data Analysis Plan
Inferential statistics will help analyze the study data calculating the mean and standard deviation of patients with a high level of cholesterol (Rigotti, 2019). This will help to get valuable information concerning people with a high level of cholesterol (“A physician-directed, nurse-managed cholesterol management program ensures optimal care for patients with high cholesterol levels”, 2020). Inferential statistics will help to make generalizations about the 80 patients with a high level of cholesterol.
Ethical Issues
Ethical issues of concern include the confidentiality of the patients’ information and the principle of beneficence. The patient information collected is to be used correctly for the study, and the participant’s accreditation is necessitated for further actions. Furthermore, the study is aimed at establishing solutions to barriers that hinder the provider’s screening for cholesterol levels and appropriate intervention to be employed in the control of the prevalence of the situation. Furthermore, the study aims at providing approaches necessary in the reduction of mortalities and morbidities like the risk of cardiovascular diseases related to high levels of cholesterol among populations. Therefore, the study is conducted for the general wellbeing of the participants and the general populations.
Limitations of the study
The study is limited to the high number of participants and variables, thereby limiting the accomplishment of desired levels of precision. Furthermore, the study is inhibited by the lack of adequate funds and facilities to facilitate the planned strategies to reach the mark of perfection. Finally, some participants fail to offer accurate data, whereas others fail to be consistent with the scheduled protocol.
Implications for Practice
The study makes a substantial contribution to the nursing practice following that it identifies the barriers to a proper screening of lipid levels and the necessary interventions to eliminate them. Besides, the study offers a literature review concerning the subject matter, thereby providing health care providers and interested parties with an insight on the scope of the problem and the interventions incorporated including their strengths and weaknesses. Therefore, the study generally furthers research concerning the behavior and methods to help improve or change it.
References
A physician-directed, nurse-managed cholesterol management programme ensures optimal care for patients with high cholesterol levels. (2020), 261(1), 6-6. https://doi.org/10.1007/bf03267081
Alageel, S., Gulliford, M. C., McDermott, L., & Wright, A. J. (2018). Implementing multiple health behaviour change interventions for cardiovascular risk reduction in primary care: a qualitative study. BMC family practice, 19(1), 171.
Bastos Brito, A., & Carvalho, G. (2017). Does the type of treatment affect who makes the decision? Secondary data analysis of patients undergoing angioplasty vs. medical treatment for high cholesterol levels. Interventional Cardiology, 09(05). https://doi.org/10.4172/interventional-cardiology.1000582
Carratala-Munuera, C., Gil-Guillen, V. F., Orozco-Beltran, D., Maiques-Galan, A., Lago-Deibe, F., Lobos-Bejarano, J. M., … & Lopez-Pineda, A. (2015). Barriers to improved dyslipidemia control: Delphi survey of a multidisciplinary panel. Family practice, 32(6), 672-680.
Grant, D. S. L., Scott, R. D., Harrison, T. N., Cheetham, T. C., Chang, S. C., Hsu, J. W. Y., … & Reynolds, K. (2018). Trends in Lipid Screening Among Adults in an Integrated Health Care Delivery System, 2009-2015. Journal of managed care & specialty pharmacy, 24(11), 1090-1101.
Lowenstern, A., Li, S., Navar, A. M., Virani, S., Lee, L. V., Louie, M. J., … & Wang, T. Y. (2018). Does clinician-reported lipid guideline adoption translate to guideline-adherent care? An evaluation of the Patient and Provider Assessment of Lipid Management (PALM) registry. American heart journal, 200, 118-124
Rigotti, P. (2019). Patients with high cholesterol levels benefit most from early withdrawal of corticosteroids. Transplantation Proceedings, 34(5), 1797-1798. https://doi.org/10.1016/s0041-1345(02)03082-8
Street, D. (2018). Controlling extraneous variables in experimental research: a research note. Extraneous Variables, 4(2), 169-188. https://doi.org/10.1080/09639289500000020
Stylianos, K. (2018). Development, Validity And Reliability of Physical Education Instructor’s Personality Description Scale. American Journal Of Applied Psychology, 3(2), 39. https://doi.org/10.11648/j.ajap.20140302.13